Achieving consensus on competency in community pediatrics.

During the past few years, changes in medical practice and curricula have heightened the need to establish guidelines for expected competencies in community pediatrics. The shift of the Accreditation Council for Graduate Medical Education (ACGME) toward an outcome-focused process for the training of physicians and the 1996 Pediatric Resident Review Committee (RRC) extended requirements for training in the community have contributed to the expectation that residency programs will define and evaluate the achievement of competency in community pediatrics. Specifically, the 1996 (as well as the revised 2003) RRC requirements called for structured educational experiences that would prepare residents to advocate on behalf of the health of children within communities. It was recommended that curricula should include but not be limited to community-oriented care with a focus on the health needs of all children within a community, particularly underserved populations; multicultural dimensions of health care; the role of the pediatrician within school and child care settings; the role of the pediatrician in the legislative process; and the role of the pediatrician in disease and injury prevention.1 Additionally, the RRC proposed a variety of settings in which these experiences potentially could take place, including communitybased primary care practices, community health resources, community-based organizations, local and state public health departments, voluntary agencies, schools and child care settings, home care services for children with special health care needs, and facilities for incarcerated youth. A competency can be defined as an ability, a proficiency, or an entire skill set that evolves over time and involves performance of behaviors based on a complex set of knowledge, skills, and attitudes.2 Translating knowledge into patient care; communicating with patients, family members, and other health care professionals; developing care plans; and advocating for the patient within the health care system are all necessary elements for physician competence. Competency-based education, unlike knowledge-based education, is not evaluated easily by traditional testing methods.3–5 Traditional evaluation emphasizes knowledge acquisition and process, whereas competency evaluation attempts to measure behaviors. Competency development for training in psychiatry,6 emergency medicine,7 geriatrics,8 preventive medicine,9 various surgical specialties,5,10 environmental health,11 and medical school curriculum12 all have been reported. Carraccio et al13 recently described the development of benchmarks based on the 6 ACGME competencies for pediatrics. In response to curricular shifts, the Curriculum Committee, a cross-site committee composed of representatives from the 10 training sites of the Anne E. Dyson Community Pediatrics Training Initiative (Table 1), developed a set of competencies to use as a resource for resident training in community pediatrics (see “Competency in Community Pediatrics: Consensus Statement of the Dyson Initiative Curriculum Committee”14 later in this supplement). It is the goal of the committee to disseminate these competencies so that they can serve as an educational tool to pediatric residency-training programs around the country.